Giriş Son yıllarda yayınlanan makaleler incelendiğinde, anestezistlerin preoperatif muayene sırasında her hastayı obstrüktif uyku apnesi (OUA) olasılığı açısından değerlendirmesinin gerekli olduğu anlaşılmaktadır. Bu gereklilik başlıca iki nedene dayanır; ilki, OUA hastalarının %80-90'ının tanı konmamış durumda olmalarıdır (1). İkinci neden ise, Amerikan Anestezistler Birliği'nin (ASA) 2006'da yayımladığı bir kılavuzla, cerrahi hastalara preoperatif dönemde OUA açısından tarama yapılmasını önermiş olmasıdır (2). Preoperatif dönemde kullanılacak uygun bir tarama ile OUA olasılığı yüksek olan hastalar belirlenip, anestezistlerin peroperatif dönemde karşı karşıya kalabilecekleri riskler en aza indirilebilir.Temel özellikleri uykuda solunumun bozulması, horlama ve gün içinde aşırı uyku hali olan OUA, erişkin popülasyonda kadınlarda %2, erkeklerde %4 oranında görülmektedir (3). OUA'nın cerrahi hastalardaki görülme sıklığına dair rakamlar değişkenlik gösterse de, bariatrik cerrahi gibi bazı özel hasta gruplarında çok yüksek oranlarda (%78) izlendiği bildirilmektedir (4-8). Peroperatif komplikasyonlar ile OUA şiddeti arasında doğrudan bir ilişki olduğu bilindiği için, hangi nedenle cerrahi geçirecek olursa olsun OUA hastalarına önceden tanı konularak gereken önlemlerin alınması büyük önem taşımaktadır (2). Bu hastalarda anestezi indüksiyonu sırasında havayolu sağlanmasında zorlukla karşılaşılabilir (9). Ekstübasyondan hemen sonra solunum yolu obstrüksiyonu görülebileceği gibi, postoperatif dönemde verilen Methods:In 110 adult patients who were admitted to the Sleep Clinic for polysomnography with an initial diagnosis of obstructive sleep apnoea, the STOP-Bang questionnaire was used to calculate the sensitivity, specificity, negative predictive value, positive predictive value and likelihood ratios. Results:In the study, no significant difference was obtained between two sexes for the presence of high risk of obstructive sleep apnoea (p>0.05). When apnoea-hypopnoea index (AHI) ≤5 patients and AHI >5 patients were compared, no significant differences were found in the values of age, sex and body mass index (p>0.05). Mean AHI value was 1.4 in AHI ≤5 patients, while it was 33.8 in AHI >5 patients (p<0.05). Although both STOP and STOP-Bang screening tests have a high sensitivity (>90%) in various severities of OSA (AHI >5, AHI >15 and AHI >30), their specificities were found to be low. As the severity of OSA increases, the positive predictive values of both tests were decreased, while the negative predictive values were increased. Conclusion
Chronic obstructive pulmonary disease (COPD) is an important public health problem and it is associated with systemic inflammation. Mean platelet volume (MPV) is one of the markers indicating platelet activation, and there are different results in different diseases related to inflammation. As for COPD some studies found it to be high whereas others found low results. In this study, we aimed to study parameters like MPV, platelet distribution volume (PDW), red blood cell (RBC), which are studied in the complete blood count testing routinely of patients with COPD, smoking and nonsmoking subjects without chronic diseases. Data of 121 patients with COPD, 101 nonsmoking subjects and 102 smoking subjects were retrospectively enrolled. Results were statistically analyzed. MPV levels were lower in patients with COPD compared with smokers (P<0.001) and nonsmoking subjects (P<0.001) but platelet levels were not significantly different. PDW levels found to be lower in COPD group compared with smokers (P<0.013) and nonsmokers (P<0.001). White blood cells were higher in patients with COPD as were expected (P<0.001). Neutrophil levels also were higher in patients with COPD compared with smokers (P<0.003) and nonsmokers (P<0.0001). RBC levels were lower in patients with COPD when compared with nonsmokers (P<0.001). The results of this study suggest that the decreased MPV and PDW may be used as negative reactants for evaluation of COPD.
Objectives: Patient-controlled analgesia (PCA) in postoperative pain treatment is more effective than conventional analgesia methods. It is commonly preferred for the reasons of maintaining high patient satisfaction and positive effects on patients' recovery period with less sedation and postoperative complications. In this study we aimed to investigate the characteristics of PCA methods that have been applied at our clinic within the last two-year period retrospectively. Methods:The records of patients who were received PCA for postoperative analgesia at our hospital between 01 January 2010 and 31 December 2011 were investigated. Patients' genders, PCA protocols and the operations' characteristics were evaluated. Results:In this study, it was seen that of the 1030 patients, IV tramadol PCA was applied to 580 (56.3%) patients, epidural PCA was applied to 431 (41.8%) patients and IV morphine PCA was applied to 19 (1.8%) patients. In 2011, it was seen that of the 971 patients, IV tramadol PCA was applied to 737 (75.9%) patients and epidural PCA was applied to 234 (24.1%) patients. When compared to 2010, it was detected that IV tramadol PCA use has significantly increased (p<0,001), whereas PCEA and IV morphine PCA uses were significantly decreased in 2011 (p<0,001 and p<0,001). In both 2010 and 2011, it was detected that PCA was applied most frequently to orthopedic surgery patients while the majority of these surgeries were lower extremity and vertebra surgeries, consequently. Conclusions:The results of this retrospective study showed that the number of PCA uses has increased over the time. In our clinic, IV PCA was used more frequently than epidural PCA while the majority of the patients whom PCA was applied was orthopedic surgery patients.
Emphysema is enlargement of alveolus, alveolary ducts and destruction of alveolary wall. One of complications of non-invasive mechanical ventilation (NIMV) is barotrauma of damaged lung. Here we present a 75 years old male who had Chronic Obstructive Pulmonary Disease (COPD), emphysema for 5 years and suffered from pneumothorax after NIMV. During treatment with NIMV his general condition deteriorated and oxygen saturation decreased immediately. Chest X-ray and tomography revealed pneumothorax. Chest tube inserted under local anesthesia. Although NIMV might seem like innocent, in patients whose general condition immediately worsens, oxygen saturation decreases, has emphysema and bullous lesions pneumothorax must be excluded. J Clin Exp Invest 2014; 5 (3): 469-471
Bu çalışmanın amacı ortalama trombosit hacmi (MPV) ve trombosit dağılım genişliğinin (PDW) bronşektazide belirteç olarak kullanılabilirliğini araştırmaktır. Bildiğimiz kadarıyla çalışmamız MPV ve PDW'nin bronşektazide önemini araştıran ilk çalışmadır. Materyal ve Metot: Kliniğimizce bronşektazi tanısı konan başka kronik bir hastalığı olmayan hastalar ile sigara içen ve içmeyen sağlıklı bireyler çalışmaya dahil edilmiştir. Toplamda 45 bronşektazili, 50 sigara içmeyen ve 50 sigara içen hastanın verileri retrospektif olarak analiz edildi. Bulgular: MPV değerleri incelendiğinde gruplar arasında istatiksel olarak anlamlı farklılık olmadığı görüldü. Trombosit (PLT) değerlerinin ise bronşektazili hastalarda hem sigara içmeyen (p <0,001) hem de sigara içen (p <0,008) gruplara göre daha yüksek olduğu görüldü. PDW değerlerinin bronşektazili hastalarda sigara içen (p <0,04) ve sigara içmeyen (p <0,02) gruba oranla daha düşük olduğu görüldü. Beyaz küre değerleri beklenildiği üzere bronşektazili hastalarda sigara içen (p <0,001) ve sigara içmeyen (p <0,004) gruplara oranla yüksek saptandı. Eozinofil değerlerine bakıldığında bronşektazili hastalarda sigara içmeyen (p <0,001) ve sigara içen (p <0,002) gruplara oranla düşük saptandı. Yine bazofil değerleri de bronşektazili hastalarda sigara içmeyen (p <0,003) ve sigara içen (p <0,005) gruplara oranla düşük saptandı. Sonuç: Bu çalışmanın sonuçları bronşektazide MPV'nin kullanılmasının anlamı olmadığını ancak PDW değerlerinin düştüğünü dolayısıyla negatif reaktan olarak kullanılabileceğini düşündürmektedir. Anahtar kelimeler: Bronşektazi, ortalama trombosit hacmi, trombosit dağılım genişliği SummaryObjectives: Aim of this study is to evaluate whether mean platelet volume (MPV) and Platelet Distribution Width (PDW) can be used as markers in bronchiectasis. To the best of our knowledge our study is the first study investigating the importance of MPV and PDW in patients with bronchiectasis. Materials and Methods: Patients in our clinic diagnosed with bronchiectasis but has no other chronic diseases, smoking and nonsmoking healthy subjects included in the study. Totally data of 45 patients with bronchiectasis, 50 nonsmoking healthy subjects and 50 smoking healthy subjects were retrospectively enrolled. Results: MPV levels were insignificant between all groups. Platelets (Plt) were high in patients with bronchiectasis when compared with nonsmokers (p <0,001) and smokers (p <0,008). PDW levels were lower in patients with bronchiectasis when compared with nonsmokers (p <0,02) and smokers (p <0,04). White blood cells were higher in patients with bronchiectasis as were expected when compared with nonsmokers (p<0,001) and smokers (p <0,004). Eosinophil levels were lower in patients with bronchiectasis when compared with nonsmokers (p <0,001) and smokers (p <0,002). Also basophil levels were lower in patients with bronchiectasis when compared with nonsmokers (p <0,003) and smokers (p <0,005). Conclusion:Results of this study suggest that MPV may not be used as a marker in bronchiectasis wher...
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